Emergency department recognition of pulmonary embolism

The cases of forty-six patients who were admitted via the Emergency Department (ED) with suspected pulmonary embolism (PE), during a ten-year period, were reviewed. Ventilation perfusion lung scans were done in all patients, and pulmonary angiography was performed in 26. Thirty-six PE patients (78%) were correctly diagnosed by emergency physicians. Ten patients (22%) were erroneously diagnosed at the ED but were proved otherwise after hospitalization. The average age of the patients was 54 years, with males dominantly 67%. Overall mortality rate was 8.7%. Predisposing risk factors for PE were documented in 20 patients (43%). Prior history of thrombophlebitis (17%) or pulmonary embolism (13%), and immobilization (13%) were significant. The most common clinical features were dyspnea (76%), pleuritic pain (74%) and hemoptysis (41%). Thirty patients (65%) had tachypnea and 20 patients (43%) had tachycardia. Chest radiographs were abnormal in 35 cases (76%), and abnormal ECG findings were noted in 27 patients (59%). However, these abnormalities of chest radiographs or ECG were not sufficiently specific to confirm or exclude the diagnosis of PE. Noninvasive or contrast venography for deep vein thrombosis were performed in 31 patients (67%), of whom 17 cases (37%) had positive results. All patient received anticoagulation treatment. And six patients had thrombolytic agents as well.